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the government recovered over 2 billion in 2018 for fraudulent healthcare reimbursements this seems like a huge amount doesn't it if the government could recover several billion dollars for a single year of medical fraud it makes me wonder how much actually occurs every year hi everyone i'm matt from etactics and today i'm going to share six types of unethical medical billing practices before we get started though make sure you subscribe to our youtube channel by clicking the button below while you're down there hit that alert bell icon next as well so when we post new helpful content you get notified [Music] upcoding is where someone assigns an inaccurate medical code for a procedure to increase reimbursement imagine a situation where a patient got routine medical transportation but that's not what the bill says a month later the bill lists the patient receiving emergency life support transportation no big deal right but the emergency life support transportation is much more expensive undercoating occurs when the codes used in the medical bill don't entirely capture all the medical services or procedures performed in other words the organization is making a false statement about the services provided and misrepresents what occurred undercoating also fits within the definition of abuse as defined by cms as misusing codes on a claim any attempt to defraud the auditing process violates federal law so although undercutting seems like it isn't that big of a deal it can lead to some serious consequences duplicate charges also known as double billing are where the same bills occur multiple times even though the patient only received the service or the treatment once of course humans are prone to make mistakes especially due to the complicated billing process but sometimes duplicate charges are intentionally made this can lead to criminal and civil penalties some of these penalties could be thousands of dollars in fines phantom charges are when a practice bills for a medical service or procedure that never occurred it can also happen when a provider submits a claim for unnecessary services this means that the treatments were only for profit for example 22 of prescription medications are unnecessary so are 25 of medical tests and 11 of procedures since all these events were unnecessary they could be legally considered as phantom charges the federal bureau of investigation defined unbundling as a practice of submitting bills in a fragmented fashion to maximize the reimbursement for various tests or procedures that are required to be built together at a reduced cost you see instead of using one code to describe services provided providers use several different codes to describe different parts of the service this increases the presumed cost of service which means a greater reimbursement for the organization medical equipment fraud is also known as durable medical equipment fraud or dme this type of fraud occurs when the provider bills for equipment the patient never received by doing this the organization can receive money for services never provided as you can see billing fraud can occur in many ways there are a few ways patients can try to avoid such types of fraud look at all the details of the statements you receive from a doctor's office and or hospital examine how many statements exist for the same service lastly question anything in your statements that look a little bit off if you'd like to learn more about unethical billing practices reach out to etactics and you're made this far into the video so you might as well like it share it and comment below what are you waiting for subscribe to our youtube channel